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Li X, Chen J, Wang B, Liu X, Jiang S, Li Z, Li W, Li Z, Wei F. Evaluating the Status and Promising Potential of Robotic Spinal Surgery Systems. Orthop Surg 2024. [PMID: 39300748 DOI: 10.1111/os.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/22/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024] Open
Abstract
The increasing frequency of cervical and lumbar spine disorders, driven by aging and evolving lifestyles, has led to a rise in spinal surgeries using pedicle screws. Robotic spinal surgery systems have emerged as a promising innovation, offering enhanced accuracy in screw placement and improved surgical outcomes. We focused on literature of this field from the past 5 years, and a comprehensive literature search was performed using PubMed and Google Scholar. Robotic spinal surgery systems have significantly impacted spinal procedures by improving pedicle screw placement accuracy and supporting various techniques. These systems facilitate personalized, minimally invasive, and low-radiation interventions, leading to greater precision, reduced patient risk, and decreased radiation exposure. Despite advantages, challenges such as high costs and a steep learning curve remain. Ongoing advancements are expected to further enhance these systems' role in spinal surgery.
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Affiliation(s)
- Xiang Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jiasheng Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ben Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiao Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zihe Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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Nagata K, Glassman SD, Brown ME, Daniels CL, Schmidt GO, Carreon LY, Hines B, Gum JL. Risk Factors of Screw Malposition in Robot-Assisted Cortical Bone Trajectory: Analysis of 1344 Consecutive Screws in 256 Patients. Spine (Phila Pa 1976) 2024; 49:780-787. [PMID: 37767783 DOI: 10.1097/brs.0000000000004827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
STUDY DESIGN Retrospective single-center study using prospectively collected data. OBJECTIVE To describe the incidence of and identify risk factors for intraoperative screw malposition secondary to skive or shift during robot-assisted cortical bone trajectory (RA-CBT) insertion. SUMMARY OF BACKGROUND DATA RA-CBT screw malposition occurs through 2 distinct modes, skive or shift. Skive occurs when a downward force applied to the cannula, drill, tap, or screw, causes the instrument to deflect relative to its bony landmark. Shift is a change in the position of the RA system relative to the patient after registration. PATIENTS AND METHODS A consecutive series of patients older than 18 years who underwent RA-CBT screw placement between January 2019 and July 2022 were enrolled. Baseline demographic and surgical data, Hounsfield Units (HUs) at L1, and vertebral shape related to screw planning were collected. Skive or shift was recorded in the operating room on a data collection form. RESULTS Of 1344 CBT screws in 256 patients, malposition was recognized intraoperatively in 33 screws (2.4%) in 27 patients (10.5%); 19 through skive in 17 and 14 through shift in 10 patients. These patients had higher body mass index than patients without malposition (33.0 vs. 30.5 kg/m 2 , P = 0.037). Patients with skive had higher HU (178.2 vs . 145.2, P = 0.035), compared with patients with shift (139.2 vs . 145.2, P = 0.935) and patients without screw malposition. More than half of the screw malposition was observed at the upper instrumented vertebra. At the upper instrumented vertebra, if the screw's overlap to the bone surface at the insertion point was decreased, skive was more likely (57% vs . 87%, P < 0.001). No patients were returned to the operating room for screw revision. CONCLUSIONS Intraoperative screw malposition occurred in 2.4% of RA-CBT. High body mass index was associated with screw malposition, regardless of etiology. Skive was associated with high HU and decreased screw overlap to the bone surface at the insertion point.
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Affiliation(s)
- Kosei Nagata
- Department of Orthopedic Surgery, University of Louisville School of Medicine, Louisville, KY
- Norton Leatherman Spine Center, Louisville, KY
| | - Steven D Glassman
- Department of Orthopedic Surgery, University of Louisville School of Medicine, Louisville, KY
- Norton Leatherman Spine Center, Louisville, KY
| | | | | | | | | | - Bren Hines
- Norton Leatherman Spine Center, Louisville, KY
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Werthmann NJ, Gum JL, Nagata K, Djurasovic M, Glassman SD, Owens RK, Crawford CH, Carreon LY. Comparison of No Tap (two-step) and tapping robotic assisted cortical bone trajectory screw insertion. J Robot Surg 2024; 18:204. [PMID: 38714574 DOI: 10.1007/s11701-024-01890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/28/2024] [Indexed: 05/10/2024]
Abstract
Workflow for cortical bone trajectory (CBT) screws includes tapping line-to-line or under tapping by 1 mm. We describe a non-tapping, two-step workflow for CBT screw placement, and compare the safety profile and time savings to the Tap (three-step) workflow. Patients undergoing robotic assisted 1-3 level posterior fusion with CBT screws for degenerative conditions were identified and separated into either a No-Tap or Tap workflow. Number of total screws, screw-related complications, estimated blood loss, operative time, robotic time, and return to the operating room were collected and analyzed. There were 91 cases (458 screws) in the No-Tap and 88 cases (466 screws) in the Tap groups, with no difference in demographics, revision status, ASA grade, approach, number of levels fused or diagnosis between cohorts. Total robotic time was lower in the No-Tap (26.7 min) versus the Tap group (30.3 min, p = 0.053). There was no difference in the number of malpositioned screws identified intraoperatively (10 vs 6, p = 0.427), screws converted to freehand (3 vs 3, p = 0.699), or screws abandoned (3 vs 2, p = 1.000). No pedicle/pars fracture or fixation failure was seen in the No-Tap cohort and one in the Tap cohort (p = 1.00). No patients in either cohort were returned to OR for malpositioned screws. This study showed that the No-Tap screw insertion workflow for robot-assisted CBT reduces robotic time without increasing complications.
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Affiliation(s)
- Neil J Werthmann
- University of Louisville School of Medicine, 500 South Preston Street. Instructional Building, Room 305, Louisville, KY, 40202, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA
| | - Kosei Nagata
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA
| | - Mladen Djurasovic
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA
| | - R Kirk Owens
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite #900, Louisville, KY, 40202, USA.
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Wang X, Li HX, Zhu QS, Zhu YH. Effectiveness and safety of robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in spinal surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:78. [PMID: 38358573 DOI: 10.1007/s11701-024-01866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
Robot-assisted (RA) technology has been shown to be a safe aid in spine surgery, this meta-analysis aims to compare surgical parameters and clinical indexes between robot-assisted cortical bone trajectory (CBT) and fluoroscopy-assisted (FA) cortical bone trajectory in spinal surgery. We searched databases such as PubMed, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure. The study selection process was guided by the PICOS (Patient/Problem, Intervention, Comparison, Outcome, Study Design) strategy. The risk of bias in non-randomized comparative studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. We performed this meta-analysis using RevMan 5.3 software (Cochrane Collaboration, Copenhagen, Denmark), and the level of statistical significance was set at P < 0.05. Six articles involving 371 patients and 1535 screws were included in this meta-analysis. RA-CBT outperformed FA-CBT in terms of various parameters, such as accuracy of pedicle screw position (both Gertzbein-Robbins scale and Ding scale), avoidance of superior facet joint violation (FJV), and reduction of neurological injury. Our meta-analysis offered a thorough evaluation of the efficacy and safety of RA-CBT in spinal surgery. The findings revealed that RA-CBT produced statistically significant results in terms of pedicle screw position accuracy and superior facet joint violation prevention. In terms of surgical parameters and clinical indexes, future research and clinical practice should investigate the efficacy of RA-CBT further. The study was registered in the PROSPERO (CRD42023466280).
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Affiliation(s)
- Xu Wang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China
| | - Hao-Xuan Li
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China.
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China.
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Kann MR, Ruiz-Cardozo MA, Brehm S, Bui T, Joseph K, Barot K, Trevino G, Carey-Ewend A, Singh SP, De La Paz M, Hanafy A, Olufawo M, Patel RP, Yahanda AT, Perdomo-Pantoja A, Jauregui JJ, Cadieux M, Pennicooke B, Molina CA. Utilization of Augmented Reality Head-Mounted Display for the Surgical Management of Thoracolumbar Spinal Trauma. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:281. [PMID: 38399568 PMCID: PMC10890598 DOI: 10.3390/medicina60020281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Augmented reality head-mounted display (AR-HMD) is a novel technology that provides surgeons with a real-time CT-guided 3-dimensional recapitulation of a patient's spinal anatomy. In this case series, we explore the use of AR-HMD alongside more traditional robotic assistance in surgical spine trauma cases to determine their effect on operative costs and perioperative outcomes. Materials and Methods: We retrospectively reviewed trauma patients who underwent pedicle screw placement surgery guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between 1 January 2021 and 31 December 2022. Outcome distributions were compared using the Mann-Whitney U test. Results: The AR cohort (n = 9) had a mean age of 66 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.1, and Surgical Invasiveness Index (SII) of 8.8. In total, 77 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 378 mL, 0.78 units transfused, 398 min spent in the operating room, and a 20-day LOS. The robotic cohort (n = 13) had a mean age of 56 years, BMI of 27.1 kg/m2, CCI of 3.8, and SII of 14.2. In total, 128 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 432 mL, 0.46 units transfused units used, 331 min spent in the operating room, and a 10.4-day LOS. No significant difference was found between the two cohorts in any outcome metrics. Conclusions: Although the need to address urgent spinal conditions poses a significant challenge to the implementation of innovative technologies in spine surgery, this study represents an initial effort to show that AR-HMD can yield comparable outcomes to traditional robotic surgical techniques. Moreover, it highlights the potential for AR-HMD to be readily integrated into Level 1 trauma centers without requiring extensive modifications or adjustments.
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Affiliation(s)
- Michael Ryan Kann
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Abigail Carey-Ewend
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Som P. Singh
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew De La Paz
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ahmed Hanafy
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rujvee P. Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander Perdomo-Pantoja
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julio J. Jauregui
- Department of Orthopedic Surgery, University of Maryland Medical System, Baltimore, MD 21201, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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6
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Han J, Guo J, Ma X, Zhang G, Han S, Zhang H, Liu H, Chen M, Wang Y. The Cortical Bone Trajectory Screw Technique Assisted by the Mazor Renaissance Robotic System as a Salvage Strategy for Failed Lumbar Spine Surgery: Technical Note and Case Series. J Pain Res 2023; 16:2971-2980. [PMID: 37664488 PMCID: PMC10474863 DOI: 10.2147/jpr.s423058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose The objective of this study was to describe the Mazor Renaissance robotic system-assisted CBT (cortical bone trajectory) screw technique as a salvage strategy for failed lumbar spine surgery. Patients and Methods Between January 2018 and June 2022, 7 patients underwent salvage surgery with the CBT screw fixation technique assisted by the Mazor Renaissance robot system in our institution. Intraoperative observations were recorded for blood loss, duration of operation, and fluoroscopy time. Complications related to CBT screws were also recorded. The accuracy of CBT screws was recorded in accordance with the modified Gertzbein-Robbins classification. The JOA (Japanese Orthopedic Association) score for low back pain was used to evaluate surgical outcomes. Results A total of 26 CBT screws were placed in 7 patients, including 4 females and 3 males. Three patients underwent ASD (adjacent segment disease) and four patients underwent lumbar union failure with loose or compromised PSs (pedicle screws). The mean operation time was 129.29 ± 32.97 minutes, the mean blood loss was 180 ± 52.60 mL, and the mean intraoperative fluoroscopy time was 14.29 ± 3.15 s. All screws were clinically acceptable according to the Gertzbein-Robbins classification. There were no complications related to CBT screws in any of the cases. The JOA scores for low back pain of all patients were significantly improved at the final follow-up. Conclusion The CBT screw fixation technique supplemented the traditional PS fixation technique, which can be performed as a salvage strategy for failed lumbar spine surgery and achieved good clinical results. The spinal robot was very helpful in evaluating pedicle size and determining CBT screw direction, especially in a previously instrumented lumbar pedicle.
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Affiliation(s)
- Jialuo Han
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Jianwei Guo
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Xuexiao Ma
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Guoqing Zhang
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Shuo Han
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Hao Zhang
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Houchen Liu
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Mingrui Chen
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Yan Wang
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
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Yamout T, Orosz LD, Good CR, Jazini E, Allen B, Gum JL. Technological Advances in Spine Surgery: Navigation, Robotics, and Augmented Reality. Orthop Clin North Am 2023; 54:237-246. [PMID: 36894295 DOI: 10.1016/j.ocl.2022.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Accurate screw placement is critical to avoid vascular or neurologic complications during spine surgery and to maximize fixation for fusion and deformity correction. Computer-assisted navigation, robotic-guided spine surgery, and augmented reality surgical navigation are currently available technologies that have been developed to improve screw placement accuracy. The advent of multiple generations of new technologies within the past 3 decades has presented surgeons with a diverse array of choices when it comes to pedicle screw placement. Considerations for patient safety and optimal outcomes must be paramount when selecting a technology.
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Affiliation(s)
- Tarek Yamout
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Lindsay D Orosz
- National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, USA
| | - Christopher R Good
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Ehsan Jazini
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Brandon Allen
- National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street Suite 900, Louisville, KY 40202, USA.
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Butler AJ, Colman MW, Lynch J, Phillips FM. Augmented reality in minimally invasive spine surgery: early efficiency and complications of percutaneous pedicle screw instrumentation. Spine J 2023; 23:27-33. [PMID: 36182070 DOI: 10.1016/j.spinee.2022.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Augmented reality (AR) employs an optical projection directly onto the user's retina, allowing complex image overlay on the natural visual field. In general, pedicle screw accuracy rates have improved with increasingly use of technology, with navigation-based instrumentation described as accurate in 89%-100% of cases. Emerging AR technology in spine surgery builds upon current spinal navigation to provide 3-dimensional imaging of the spine and powerfully reduce the impact of inherent ergonomic and efficiency difficulties. PURPOSE This publication describes the first known series of in vivo pedicle screws placed percutaneously using AR technology for MIS applications. STUDY DESIGN / SETTING After IRB approval, 3 senior surgeons at 2 institutions contributed cases from June, 2020 - March, 2022. 164 total MIS cases in which AR used for placement of percutaneous pedicle screw instrumentation with spinal navigation were identified prospectively. PATIENT SAMPLE 155 (94.5%) were performed for degenerative pathology, 6 (3.6%) for tumor and 3 (1.8%) for spinal deformity. These cases amounted to a total of 606 pedicle screws; 590 (97.3%) were placed in the lumbar spine, with 16 (2.7%) thoracic screws placed. OUTCOME MEASURES Patient demographics and surgical metrics including total posterior construct time (defined as time elapsed from preincision instrument registration to final screw placement), clinical complications and instrumentation revision rates were recorded in a secure and de-identified database. METHODS The AR system used features a wireless headset with transparent near-eye display which projects intra-operative 3D imaging directly onto the surgeon's retina. After patient positioning, 1 percuntaneous and 1 superficial reference marker are placed. Intra-operative CT data is processed to the headset and integrates into the surgeon's visual field creating a "see-through" 3D effect in addition to 2D standard navigation images. MIS pedicle screw placement is then carried out percutaneously through single line of sight using navigated instruments. RESULTS Time elapsed from registration and percutaneous approach to final screw placement averaged 3 minutes and 54 seconds per screw. Analysis of the learning curve revealed similar surgical times in the early cases compared to the cases performed with more experience with the system. No instrumentation was revised for clinical or radiographic complication at final available follow-up ranging from 6-24 months. A total of 3 screws (0.49%) were replaced intra-operatively. No clinical effects via radiculopathy or neurologic deficit postoperatively were noted. CONCLUSIONS This is the first report of the use of AR for placement of spinal pedicle screws using minimally invasive techniques. This series of 164 cases confirmed efficiency and safety of screw placement with the inherent advantages of AR technologies over legacy enabling technologies.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Liu D, Kahaer A, Wang Y, Zhang R, Maiaiti A, Maimaiti X, Zhou Z, Shi W, Cui Z, Zhang T, Li L, Rexiti P. Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory. BMC Surg 2022; 22:441. [PMID: 36575417 PMCID: PMC9795663 DOI: 10.1186/s12893-022-01893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. METHODS CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20-30 years old group and 20 male and 20 female cases in the 30-40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. RESULTS The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). CONCLUSIONS According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.
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Affiliation(s)
- Dongshan Liu
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Alafate Kahaer
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Yixi Wang
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maiaiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Xieraili Maimaiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Zhihao Zhou
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Wenjie Shi
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Zihao Cui
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Tao Zhang
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Longfei Li
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
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10
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Guo S, Zhu K, Yan MJ, Li XH, Tan J. Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis. World J Clin Cases 2022; 10:13179-13188. [PMID: 36683619 PMCID: PMC9850985 DOI: 10.12998/wjcc.v10.i36.13179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022] Open
Abstract
Lumbar degenerative disc disease (DDD) in the elderly population remains a global health problem, especially in patients with osteoporosis. Osteoporosis in the elderly can cause failure of internal fixation. Cortical bone trajectory (CBT) is an effective, safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis. In this review, we analyzed the anatomy, biomechanics, and advantages of the CBT technique in lumbar DDD and revision surgery. Additionally, the clinical trials and case reports, indications, advancements and limitations of this technique were further discussed and reviewed. Finally, we concluded that the CBT technique can be a practical, effective and safe alternative to traditional pedicle screw fixation, especially in DDD patients with osteoporosis.
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Affiliation(s)
- Song Guo
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Kai Zhu
- Department of Orthopedics Ⅱ, Qingdao No. 8 People’s Hospital, Qingdao 266121, Shandong Province, China
| | - Mei-Jun Yan
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xin-Hua Li
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Jun Tan
- Department of Orthopedics, United Family Healthcare, Shanghai 200336, China
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11
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Mualem W, Onyedimma C, Ghaith AK, Durrani S, Jarrah R, Singh R, Zamanian C, Nathani KR, Freedman BA, Bydon M. R2 advances in robotic-assisted spine surgery: comparative analysis of options, future directions, and bibliometric analysis of the literature. Neurosurg Rev 2022; 46:18. [PMID: 36515789 DOI: 10.1007/s10143-022-01916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spine surgery has undergone rapid advancements over the past several decades with the emergence of robotic and minimally invasive surgery (MIS). While conventional MIS spine surgery has had relative success, its complication profile has warranted continued efforts to improve clinical outcomes. We discuss the functional, clinical, and financial aspects of four robotic options for spinal pathologies, namely ROSA, Mazor X, Da Vinci, and ExcelsiusGPS, and conduct a bibliometric analysis to better understand current trends and applications of these robots as the field of robotic spine surgery continues to grow. An extensive search of English-language published literature on robotic-assisted spinal surgery was performed in Elsevier's Scopus database. A bibliometric analysis was then performed on the top 100 most cited papers. The search yielded articles regarding robotic-assisted spine surgery application, limitations, and functional outcomes secondary to spine pathology. Accuracy analyses of 1733 screw placements were reviewed. The top 100 papers were published between 1992 and 2020, with a significant increase from 2015 onwards. The top publishing institution was John Hopkins University (n = 8). The top contributing author was Dr. Isador H. Lieberman (n = 6). The USA (n = 34) had the most articles on robotic spinal surgery, followed by Germany (n = 12). This review examines robotic applications in spine surgery, including four available options: ROSA, Mazor X, Da Vinci, and ExcelsiusGPS. Publication output over time, surgical outcomes, screw accuracy, and cost-effectiveness of these technologies have been investigated here. Certain robots have functional, clinical, and financial differences worth noting. Given the dearth of existing literature reporting postoperative complications and long-term comparative outcomes, there is a clear need for further studies on this matter.
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Affiliation(s)
- William Mualem
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Chiduziem Onyedimma
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Sulaman Durrani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Ryan Jarrah
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Rohin Singh
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Department of Neurologic Surgery, Mayo Clinic, Scottsdale, AZ, USA
| | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Karim Rizwan Nathani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
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12
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Li C, Zhang T, Wang H, Hou Z, Zhang Y, Chen W. Advanced surgical tool: Progress in clinical application of intelligent surgical robot. SMART MEDICINE 2022; 1:e20220021. [PMID: 39188736 PMCID: PMC11235784 DOI: 10.1002/smmd.20220021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2024]
Abstract
Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.
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Affiliation(s)
- Chao Li
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Tongtong Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Haoran Wang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Zhiyong Hou
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
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13
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Pérez de la Torre RA, Ramanathan S, Williams AL, Perez-Cruet M. Minimally-Invasive Assisted Robotic Spine Surgery (MARSS). Front Surg 2022; 9:884247. [PMID: 35903260 PMCID: PMC9316616 DOI: 10.3389/fsurg.2022.884247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Minimally-Invasive robotic spine surgery (MARSS) has expanded the surgeons armamentarium to treat a variety of spinal disorders. In the last decade, robotic developments in spine surgery have improved the safety, accuracy and efficacy of instrumentation placement. Additionally, robotic instruments have been applied to remove tumors in difficult locations while maintaining minimally invasive access. Gross movements by the surgeon are translated into fine, precise movements by the robot. This is exemplified in this chapter with the use of the da Vinci robot to remove apical thoracic tumors. In this chapter, we will review the development, technological advancements, and cases that have been conducted using MARSS to treat spine pathology in a minimally invasive fashion.
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Affiliation(s)
| | - Siddharth Ramanathan
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
| | - Ashley L. Williams
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
| | - Mick J. Perez-Cruet
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
- Michigan Head and Spine Institute, Southfield, MI, United States
- Correspondence: Mick Perez-Cruet
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14
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Liounakos JI, Khan A, Eliahu K, Mao JZ, Good CR, Pollina J, Haines CM, Gum JL, Schuler TC, Jazini E, Chua RV, Shafa E, Buchholz AL, Pham MH, Poelstra KA, Wang MY. Ninety-day complication, revision, and readmission rates for current-generation robot-assisted thoracolumbar spinal fusion surgery: results of a multicenter case series. J Neurosurg Spine 2022; 36:841-848. [PMID: 34826805 DOI: 10.3171/2021.8.spine21330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems. METHODS An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days. RESULTS In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases. CONCLUSIONS The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.
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Affiliation(s)
| | - Asham Khan
- 2Department of Neurosurgery, University at Buffalo, New York
| | - Karen Eliahu
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Jennifer Z Mao
- 2Department of Neurosurgery, University at Buffalo, New York
| | | | - John Pollina
- 2Department of Neurosurgery, University at Buffalo, New York
| | | | - Jeffrey L Gum
- 4Norton Leatherman Spine Center, Louisville, Kentucky
| | | | | | | | - Eiman Shafa
- 6Twin Cities Spine Center, Minneapolis, Minnesota
| | - Avery L Buchholz
- 7Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Martin H Pham
- 8Department of Neurosurgery, UC San Diego School of Medicine, La Jolla, California; and
| | | | - Michael Y Wang
- 1Department of Neurological Surgery, University of Miami, Florida
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15
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Carlson JB, Zou J, Hartley B. Placement of LC-II and trans-sacral screws using a robotic arm in a simulated bone model in the supine position - a feasibility study. J Exp Orthop 2022; 9:36. [PMID: 35476163 PMCID: PMC9046512 DOI: 10.1186/s40634-022-00476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose The use of a robotic arm has been well-described in the literature for the placement of pedicle screws in spine surgery as well as implants for sacroiliac joint fusion. There are no reports describing the use of a robotic arm to place screws in osseous fixation pathways (OFPs) employed in the treatment of pelvic ring and acetabular fractures outside of a single center in China. Using a Sawbones model, the authors describe a technique for using a robotic arm widely available in Europe and the Americas for placement of 6.5 mm cannulated screws into two OFPs commonly used in the treatment of pelvic and acetabular fractures. Methods Using the Mazor X Stealth Edition (MSXE) robot from Medtronic, the authors were able to place a pin into the pelvis onto which the robot was docked. The authors were then able to designate the area of interest using navigated instruments, and in combination with the MSXE “scan and plan” marker, obtain cross-sectional imaging using the O-Arm and successfully register the MSXE robot. We then used the provided software to plan trajectories for the lateral compression type 2 (LC-II) screw pathway as well as a pathway for a trans-ilio-trans-sacral screw. We describe in detail the steps for setup, planning and placement of 6.5 mm cannulated screws using the MSXE robotic arm into these two OFPs. Results Visual inspection and plain x-rays demonstrated successful placement of the screws into the two planned OFPs. No breach of cortical bone was seen on either visual inspection of the model or demonstrated on post-procedure x-rays. Conclusion It is possible to use the Mazor X Stealth Edition robot to place screws into the LC-II and trans-ilio-transsacral screw pathways in a Sawbones model. This is only a feasibility study, and should in no way be taken to suggest that clinical application of this technique should be attempted.
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Affiliation(s)
- Jon B Carlson
- Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St 1st Floor ACB, Louisville, KY, 40292, USA.
| | - Jiyao Zou
- Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St 1st Floor ACB, Louisville, KY, 40292, USA
| | - Brandi Hartley
- Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St 1st Floor ACB, Louisville, KY, 40292, USA
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16
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Pojskić M, Bopp M, Nimsky C, Carl B, Saβ B. Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq ® Robotic Alignment: An Evaluation of the First 70 Screws. J Clin Med 2021; 10:jcm10245725. [PMID: 34945020 PMCID: PMC8703981 DOI: 10.3390/jcm10245725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab's Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). METHODS All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. RESULTS A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. CONCLUSION Brainlab's Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.
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Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Correspondence: ; Tel.: +49-642-1586-9848
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
| | - Benjamin Saβ
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
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17
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Matsukawa K, Yanai Y, Fujiyoshi K, Kato T, Yato Y. Depth of vertebral screw insertion using a cortical bone trajectory technique in lumbar spinal fusion: radiological significance of a long cortical bone trajectory. J Neurosurg Spine 2021; 35:601-606. [PMID: 34388711 DOI: 10.3171/2021.2.spine202229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/11/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Contrary to original cortical bone trajectory (CBT), "long CBT" directed more anteriorly in the vertebral body has recently been recommended because of improved screw fixation and load sharing within the vertebra. However, to the authors' knowledge there has been no report on the clinical significance of the screw length and screw insertion depth used with the long CBT technique. The aim of the present study was to investigate the influence of the screw insertion depth in the vertebra on lumbar spinal fusion using the CBT technique. METHODS A total of 101 consecutive patients with L4 degenerative spondylolisthesis who underwent single-level posterior lumbar interbody fusion at L4-5 using the CBT technique were included (mean follow-up 32.9 months). Screw loosening and bone fusion were radiologically assessed to clarify the factors contributing to these outcomes. Investigated factors were as follows: 1) age, 2) sex, 3) body mass index, 4) bone mineral density, 5) intervertebral mobility, 6) screw diameter, 7) screw length, 8) depth of the screw in the vertebral body (%depth), 9) facetectomy, 10) crosslink connector, and 11) cage material. RESULTS The incidence of screw loosening was 3.1% and bone fusion was achieved in 91.7% of patients. There was no significant factor affecting screw loosening. The %depth in the group with bone fusion [fusion (+)] was significantly higher than that in the group without bone fusion [fusion (-)] (50.3% ± 8.2% vs 37.0% ± 9.5%, respectively; p = 0.001), and multivariate logistic regression analysis revealed that %depth was a significant independent predictor of bone fusion. Receiver operating characteristic curve analysis identified %depth > 39.2% as a predictor of bone fusion (sensitivity 90.9%, specificity 75.0%). CONCLUSIONS This study is, to the authors' knowledge, the first to investigate the significance of the screw insertion depth using the CBT technique. The cutoff value of the screw insertion depth in the vertebral body for achieving bone fusion was 39.2%.
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Judy BF, Pennington Z, Botros D, Tsehay Y, Kopparapu S, Liu A, Theodore N, Zakaria HM. Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve. Int J Spine Surg 2021; 15:S28-S37. [PMID: 34675029 DOI: 10.14444/8138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David Botros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hesham M Zakaria
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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19
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Avrumova F, Sivaganesan A, Alluri RK, Vaishnav A, Qureshi S, Lebl DR. Workflow and Efficiency of Robotic-Assisted Navigation in Spine Surgery. HSS J 2021; 17:302-307. [PMID: 34539271 PMCID: PMC8436346 DOI: 10.1177/15563316211026658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ahilan Sivaganesan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ram Kiran Alluri
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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20
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Lee NJ, Zuckerman SL, Buchanan IA, Boddapati V, Mathew J, Leung E, Park PJ, Pham MH, Buchholz AL, Khan A, Pollina J, Mullin JP, Jazini E, Haines C, Schuler TC, Good CR, Lombardi JM, Lehman RA. Is there a difference between navigated and non-navigated robot cohorts in robot-assisted spine surgery? A multicenter, propensity-matched analysis of 2,800 screws and 372 patients. Spine J 2021; 21:1504-1512. [PMID: 34022461 DOI: 10.1016/j.spinee.2021.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2021] [Accepted: 05/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Robot-assisted spine surgery continues to rapidly develop as evidenced by the growing literature in recent years. In addition to demonstrating excellent pedicle screw accuracy, early studies have explored the impact of robot-assisted spine surgery on reducing radiation time, length of hospital stay, operative time, and perioperative complications in comparison to conventional freehand technique. Recently, the Mazor X Stealth Edition was introduced in 2018. This robotic system integrates Medtronic's Stealth navigation technology into the Mazor X platform, which was introduced in 2016. It is unclear what the impact of these advancements have made on clinical outcomes. PURPOSE To compare the outcomes and complications between the most recent iterations of the Mazor Robot systems: Mazor X and Mazor X Stealth Edition. STUDY DESIGN Multicenter cohort PATIENT SAMPLE: Among four different institutions, we included adult (≥18 years old) patients who underwent robot-assisted spine surgery with either the Mazor X (non-navigated robot) or Stealth (navigated robot) platforms. OUTCOME MEASURES Primary outcomes included robot time per screw, fluoroscopic radiation time, screw accuracy, robot abandonment, and clinical outcomes with a minimum 90 day follow up. METHODS A one-to-one propensity-score matching algorithm based on perioperative factors (e.g. demographics, comorbidities, primary diagnosis, open vs. percutaneous instrumentation, prior spine surgery, instrumented levels, pelvic fixation, interbody fusion, number of planned robot screws) was employed to control for the potential selection bias between the two robotic systems. Chi-square/fisher exact test and t-test/ANOVA were used for categorical and continuous variables, respectively. RESULTS From a total of 646 patients, a total of 372 adult patients were included in this study (X: 186, Stealth: 186) after propensity score matching. The mean number of instrumented levels was 4.3. The mean number of planned robot screws was 7.8. Similar total operative time and robot time per screw occurred between cohorts (p>0.05). However, Stealth achieved significantly shorter fluoroscopic radiation time per screw (Stealth: 7.2 seconds vs. X: 10.4 seconds, p<.001) than X. The screw accuracy for both robots was excellent (Stealth: 99.6% vs. X: 99.1%, p=0.120). In addition, Stealth achieved a significantly lower robot abandonment rate (Stealth: 0% vs. X: 2.2%, p=0.044). Furthermore, a lower blood transfusion rate was observed for Stealth than X (Stealth: 4.3% vs. X: 10.8%, p=0.018). Non-robot related complications such as dura tear, motor/sensory deficits, return to the operating room during same admission, and length of stay was similar between robots (p>0.05). The 90-day complication rates were low and similar between robot cohorts (Stealth: 5.4% vs. X: 3.8%, p=0.456). CONCLUSION In this multicenter study, both robot systems achieved excellent screw accuracy and low robot time per screw. However, using Stealth led to significantly less fluoroscopic radiation time, lower robot abandonment rates, and reduced blood transfusion rates than Mazor X. Other factors including length of stay, and 90-day complications were similar.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
| | - Scott L Zuckerman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ian A Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul J Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Martin H Pham
- Department of Neurosurgery, University of San Diego Health, Sand Diego, CA, USA
| | - Avery L Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Asham Khan
- Department of Neurosurgery, State University of New York, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, State University of New York, Buffalo, NY, USA
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Thomas C Schuler
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | | | - Joseph M Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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